On Supreme Court Steps, a Health-Care Dream Deferred

No matter what the ultimate fate of the law is at the hands of the nine justices, because of the individual mandate, and because the opponents of the law were vastly more gifted at caricaturing it than the administration was in defending it, the fight is over in the country, and the Affordable Care Act lost

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Mark Wilson/GettyBEYOND THE HOWLING /// "We actually could have accomplished those things," a supporter says of the Affordable Care Act's doomed policies, "without a year and a half of incredibly expensive drawn-out legal maneuvering."

WASHINGTON — At the end of the working day — which, for the Supreme Court, occurs roughly at lunch time — I had quite had it with the chanting and the singing from both sides of the argument, and with the guys dressed up like members of the Continental Army, and all the rest of the democratic dumbshow on the steps of the Supreme Court building, and so I hied myself off down Capitol Hill to a window table at the Dubliner, and a quiet pint of my own. I wasn't sitting there five minutes when a bevy of oldsters, all nattily attired in brilliant red T-shirts furnished to them through the good graces of Americans for Prosperity, went wandering past my window. One of them had a sign: RESPECT THE 10TH AMENDMENT. Another had a placard that showed President Obama along with his fellow tyrants, most notably Joseph Stalin and that Hitler fellow. A third was holding a big white piece of cardboard warning the whole wide world to keep its hands off the fellow's health care. And all this, I thought, over a question that comes down to exactly how well off America's health-insurance companies are going to be for the next decade or so.

The question came up when I first hit the steps in the early morning. Dr. Carol Paris, a psychiatrist from Maryland, was holding a large sheet — SINGLE PAYER NOW, it read — and she and her two colleagues were the loneliest people on the avenue. One side was chanting, "Ho-ho, hey-hey, Obamacare is here to stay." Under a bouquet of Gadsden flags, the other side was chanting, "Hey-hey, ho-ho, Obamacare has got to go." The former was marching in support of the Affordable Care Act, the insurance-friendly compromise mutant that the administration was able to squeeze through Congress, the fate of which was, at the moment, being decided in the silent chambers at the top of the stairs. The other bunch was howling in opposition, and dedicated to the proposition that requiring people to buy health insurance as a vehicle to move the country toward universal coverage was the greatest affront to American liberty since the Townshend Acts. No matter what they might argue to the contrary, the people supporting the law are also supporting the government-sponsored delivery of 30 million new customers into the arms of one of the most disliked industries in America. No matter what they might argue to the contrary, the other side was supporting the notion that government can do nothing whatsoever to ameliorate the circumstances of people who simply will sicken and die because they can't afford not to sicken and die. (Pushed to the wall on this, the people opposed to the ACA will admit that the health-care system needs "reform." Asked what that means, the first club out of their bag is "tort reform," which is a dead giveaway that these people are in no way serious.) Carol Paris stood in the middle of it all, her sign an appeal to one of the great lost golden dreams of health-care reform, and nobody from either side was much interested in talking to her.

"What I would say is that the reason we're sort of lost here is that we're not part of the Democratic or the Republican media machine, or corporate machine," Dr. Paris told me. "This crowd is the Democratic corporate machine, spending a lot of money getting people to support Obamacare. And then, across the way, is going to be the Republican corporate machine saying that Obamacare is just the worst thing in the world. We're actually saying that the Obama legislation accomplishes a few good things, that it has a few good ideas, that I'm not against in the short-term — getting rid of the pre-existing conditions, kids being able to stay on their parents' plans. We actually could have accomplished those things with insurance reform without a year and a half of incredibly expensive drawn-out legal maneuvering."

Paris has been at this a while. She was arrested at one of the early congressional hearings at which single-payer — and its orphaned child, the public option — were both being sold down the river. She has no patience with either the argument that the whole notion of national health care is an affront to human freedom, or the argument that the current law is merely a stepping-stone to better things in the future. "Since I don't have any skin in the game, I'm not a Democrat and I'm not a Republican," she told me. At the end of the year, Paris said, she is "professionally repatriating" to New Zealand, where she will practice for six months of the year before coming back to the United States where, she says, she "no longer will have to be part of this insane system and can devout all my time to working for single-payer."

"I do not buy that this is a stepping stone," Paris says, "because the only way you can get the good things of this legislation is to have the individual mandate, and the individual mandate is an awful step backwards because it gives all these poor people the misguided illusion that they've actually accomplished health-care reform and they have not. This is not a long-term solution."

She went back to holding her sign, then, a strange historical curiosity in a sea of abandoned emotion.

There is one thing that is very clear from standing on the steps. No matter what the ultimate fate of the law is at the hands of the nine justices, because of the individual mandate, and because the opponents of the law were vastly more gifted at caricaturing it than the administration was in defending it, the fight is over in the country, and the Affordable Care Act lost. The case for it is equal parts defending the marginally indefensible (the mandate); trying to get the country to notice, over the political cacophony, that people are no longer being denied care at the whim of an insurance company bureaucrat; trying to keep the country from noticing that the for-profit insurance companies are going to be central to the American health-care system for the foreseeable future; and promoting the hell out of benefits that have yet to kick in. That's an awfully tough sell, and the administration has sold it so badly that 72 percent of the American people believe the whole thing to be unconstitutional, and 25 percent of the country in one poll thinks the law already has been repealed.

Against that, we have the noisy simplicity of people like Ralph Reed, who apparently has rolled away the stone from the tomb in which Jack Abramoff and his own greed entombed his career, who got up behind the Tea Party podium here and announced that "Obamacare is a dagger pointed directly at the heart of religious freedom." (Reed went on to lie about federal funding of abortions, and about death panels, and generally treated his audience like the suckers who used to follow him into Indian casinos. They cheered anyway.) We had Representative Steve King of Iowa, taking a break from looking for Muslims and immigrants uner his dust ruffles, talking about "an argument called the Commerce Clause." And we have the homespun dumbassery of Rep. Louie Gohmert — whom we met in an earlier post today — following Reed's slime-trail to the microphone, and announcing, "The same government-run health care that says you have to buy this insurance is the same government-run health care that can tell you that, well, this costs too much, so you're not going to have your privacy rights anymore."

And it is here where we point out that, of all the people in the crowd, King and Gohmert likely were the only ones who benefit from a government-run, single-payer health-care system. Both of them look very healthy, despite the jackboot of tyranny they have permanently affixed to the back of their necks.

Ultimately, it was a sad and depressing spectacle. The emotions were disproportionate. The professionalism of it all drained the spontaneity and humanity out of the action on the steps. The people in favor of the law showed up organized, with handsome signs, and lyric sheets for their cheers, and sharp young folks with walkie-talkies directing the action. The opposition was disorganized until all those red T-shirts began to appear right about the time that arguments inside the Court were concluding for the day. Their chants got more rhythmic, their marching more disciplined. The emotions were disproportionate. On one side, people marched to support a bill. On the other, people marched for what they have been endlessly told was a cause. And that, alas, makes all the difference.